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Real-time data: The best of times, the worst of times for physician practices

With widespread adoption of electronic health records (EHR) by hospitals and physician practices, the potential for improving patient care through collection and analysis of data has never been greater.

"It was the best of times, it was the worst of times." These are the words with which Charles Dickens begins A Tale of Two Cities. Today, these same opening lines could easily apply to A Tale of Two Practices. In some ways, it is truly the best of times for health care, with innovative medical practices using automated, real-time data to improve patient satisfaction and outcomes while reducing costs and easing the burden of regulatory requirements.

However, many physicians feel like it is "the worst of times," with meaningful use (MU), ICD-10 and the Physician Quality Reporting System chipping away at their margins, which have already been thinned by the U.S. Centers for Medicare and Medicaid Services (CMS) and other payers. A recent study showed that physician satisfaction with EHRs is on the decline as well, according to the American College of Physicians. Many physicians inhabit a world of disconnected data sources, lagging data entry and retrospective, manual chart reviews. Unable to see data in real-time or query the unstructured notes in their electronic files, they remain unable to proactively identify issues and can only take action weeks or months later.

Automating regulatory reporting with big data tools

A recent study by the Robert Wood Johnson Foundation found that only half of the office-based physicians in the U.S. have adopted a basic EHR system and a mere 20 percent attested to Stage 2 MU. For this cohort, real-time data is a myth.

In the current regulatory environment, physicians have struggled with lack of adequate staff, compliance with MU attestation and maximizing reimbursement under ICD-10, which went live on Oct. 1. Many physicians have accepted financial penalties, which continue to erode their practice's revenues. Others are personally involved in compliance and reporting, resulting in less face time with patients and less revenue.

However, there are physicians who have found ways to automate regulatory reporting and use electronic data to provide better care for patients. These practices are using big data tools to extract and create discrete data from their unstructured electronic notes, allowing them to automatically complete allergy lists or tailor specific preventive care efforts to individual patients.

Transforming the quality of care with data analytics

Pioneering practices have proven the value of automated, real-time data tools. Now able to combine and process data from various physical locations and systems, they have been able to measurably cut down on the time it takes to generate referrals or provide care.

For example, ambulatory surgery centers have benefited from visualization tools, which use real-time data to track the progress of patients through pre-op, operating room and post-op areas. Dashboards and graphic displays convey key information instantaneously, allowing the facility to speed up turnover times and reduce pre-op wait times. Further, radio-frequency identification technology and artificial intelligence in data analytics are beginning to provide physicians with advanced insights and recommendations that improve diagnosis and treatments.

Improved patient outcomes: Learning from Netflix and Amazon

With a greater portion of provider payments hinging on patient outcomes, the value of real-time data for quality improvement efforts is on the rise. Streaming data into predictive models has been used to prevent sepsis, rather than counting sepsis diagnoses after the fact — saving lives and money.

As presented at the AMIA Joint Summits on Translational Science, researchers have been investigating clinical order recommendation technology, using methods similar to those employed by Netflix and Amazon to recommend new shows or purchases. Substitute the mentality of "customers who bought product A are more likely to buy product B" with "patients with condition A are more likely to need treatment B," and the results include customized patient education and preventive care.

Big data tools offer new opportunities to use analytics to take timely actions that often result in reduced costs, improved quality of care and more satisfied patients. However, the benefits are currently distributed unevenly across the physician community. For practices willing to embrace these tools, this could be the best of times, with faster, more effective, patient-friendly processes that are informed by instantaneous decision support.

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